Q: I love to exercise. How safe is it to exercise during pregnancy or while breastfeeding?
A: Staying fit throughout pregnancy and breastfeeding is a realistic goal as long as the expecting mom consults an expert regarding what activities, lengths of time and levels of activity are safe. Even certain stretching activities can interfere with the blood supply to the baby so it’s extra important for moms to do all of their workouts with the input and/or supervision of a physical therapist or exercise physiologist.
Any exercise that involves bouncing, jarring, leaping or the risk of falling (i.e. biking, horseback riding, and skiing) is not recommended during pregnancy as falls increase the chance of losing the baby. Also, pregnant women’s ligaments are not as strong as they normally are so it’s easier to cause damage to them. Extreme activities, such as exercising above 6,000 feet or scuba diving, are definitely not allowed.
The fetus is directly affected by its mother's body temperature. Any activity that she does in hot weather or that causes overheating puts the baby at risk for midline defects, especially in the early stages of pregnancy; so it is important for pregnant moms to stay relatively cool and to be well hydrated during exercise.
If there is a history of the following conditions, exercise may be contra-indicated:
- Premature birth
- Vaginal bleeding
- Dizziness
- Chest pains
- Uterine pains
- Shortness of breath
- Early rupture of membranes with amniotic fluid leakage
- Intra-uterine growth retardation
- Placenta previa
The exercises which experts do suggest during pregnancy are: walking, swimming, water aerobics, Pilates and yoga because they are all low-impact activities.
The public's interest in exercise during pregnancy continues to grow each year. There is now a program available to help expectant moms decide on the quality and quantity of physical activity they can safely engage in while pregnant. It’s called Fit to Deliver and was co-created by Vancouver family physician, Dr Karen Nordall.
Fit to Deliver comes in the form of a book as well as a web site that sets out their program in exact detail (see www.fittodeliver.com). The web site includes a complete question and answer section for those who have more specific questions. Fit to Deliver also offers prenatal and postpartum fitness classes in Vancouver, BC, Canada and continuing education programs for fitness professionals/personal trainers in Canada, the US and the UK.
This program has experienced much success all over North America, so if you’re interested in staying active during pregnancy and would like more information on future classes in the Calgary area call 280-9728.
There are also magazines available that help expecting moms keep fit while pregnant (See www.fitpregnancy.com). One word of caution, though, not all of the claims in these magazines (as logical as they may sound) are based on a sound overview of all the collected scientific data on this topic. (The Cochrane literature reviews are a great resource for integrating all scientific data such that doctors, like me, can practice evidence based medicine, and provide sound advice to people like you).
The benefits of fitness during pregnancy include:
- More energy
- Fewer backaches
- Better posture
- Less constipation
- Better sleep
- Stronger muscles
- Better cardiovascular health
- Less risk of diabetes and pregnancy-related hypertension
- Easier breathing
- Faster return to pre-pregnancy body shape
Unfortunately, there are still a number of unanswered questions, conflicting and scant data when it comes to exercise and pregnancy.
The American College of Obstetrics and Gynecology published their exercise guidelines in 2002. These guidelines were based on recent published data but even now, there is still some question as to the role that exercise plays in reducing labor duration and the intervention required.
In March 2005, the Journal of Reproductive Medicine (Vol. 50; 3: p181-188) published an article from the doctors of the famous Brigham and Women's Hospital in Boston. The doctors received conflicting results when they asked, “Do women who exercise during pregnancy experience shorter labor?” and, “Are obstetrical interventions less likely in women who exercised during pregnancy?”
There are also no clear answers regarding what the majority of doctors are telling their pregnant patients about exercise and what the implications are for babies in Canada. In the USA it is much more common for pediatricians (who have a keen interest in having healthy mothers because the healthier the mother, the healthier the baby) to meet with expecting moms during pregnancy. In Canada the task, falls mainly to family doctors or obstetricians.
There is also very little data to support the common-sense expectation that mothers who are fit during pregnancy are less likely to suffer from post-partum depression. Post-partum depression is relatively common, but it is frequently overlooked. (An expecting mom who already suffers from depression must keep in mind that the use of antidepressants, such as the Selective Serotonin Reuptake Inhibitors [i.e. Paxil, Prozac, etc.] during pregnancy, has been associated with complications at birth requiring prolonged hospitalization, breathing support and tube feeding. Reported symptoms include: feeding and/or breathing difficulties, seizures, muscle rigidity, jitteriness and constant crying. See http://www.hc-sc.gc.ca/english/protection/warnings/2004/2004_44.htm)
As for how exercise affects breastfeeding, there are a few factors to consider. There was an interesting article, in the electronic pages of Pediatrics (Feb. 2003, e148-152) that found that moderate exercise did not adversely affect the quality of breast milk. On the other hand, mothers who engaged in strenuous exercise had milk with significantly below normal levels of key immunoglobulins.
Another study (Pediatrics, April 2002), discovered that strenuous activity did not negatively affect the taste of breast milk one hour after exercise. (The theory was that activity may increase the lactic acid levels in breast milk and therefore affect the taste)
The bottom line is that mothers who are moderately physically active during and after pregnancy, especially those who work out with help from qualified trainers and physiotherapists, benefit not only themselves, but also their babies. For much more detail on this important topic see www.fittodeliver.com or contact Life Mark Health's Fitness Through Pregnancy program (403. 280-9728) in Calgary.
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